Skip to main content

Advertisement

Log in

Characteristics and quality of pediatric cost-utility analyses

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

Measuring utility for cost-utility analysis (CUA) is challenging in children. The objectives were to characterize pediatric CUAs, appraise their quality, and identify determinants of higher quality.

Methods

Descriptive data were imported from the PEDE database for 305 pediatric CUAs published from 1997 to 2009, and quality was rated using the Pediatric Quality Appraisal Questionnaire (PQAQ) in 213 studies. The impact on quality of publication year, journal type, and whether utility was measured was analyzed using multiple regression.

Results

CUAs increased over time and the largest proportion was from North America (38%). Children aged 1–12 years (39%) and preventative interventions (51%) were studied most frequently. Whereas a societal perspective was most common in papers published before 2007 (49%), a third-party payer perspective was subsequently most frequent (63%). Utility was measured prospectively in 8% of studies. Domains that demonstrated the poorest quality were Perspective, Costs and resource use, Outcomes, Analysis, Incremental analysis and Conflict of interest. Quality increased significantly over time for most domains and was greater in studies published in methods/health economic journals.

Conclusions

The quality of pediatric CUAs is increasing. Few studies ascertain utility prospectively, suggesting the need for better instruments for pediatric health state valuation and measurement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. The Canadian Agency for Drugs and Technologies in Health. (2006). Guidelines for the economic evaluation of health technologies: Canada. The Canadian agency for drugs and technologies in health. http://www.cadth.ca/media/pdf/186_EconomicGuidelines_e.pdf. Accessed 12 March 2010.

  2. National Institute for Health and Clinical Excellence. (2010). Guide to the methods of technology appraisal. National Health Service. http://www.nice.org.uk/. Accessed 5 April 2010.

  3. Drummond, M., Sculpher, M., Torrance, G., O’Brien, B. J., & Stoddart, B. J. (2005). Methods for the economic evaluation of health care programmes (3rd ed.). Oxford: Oxford University Press.

    Google Scholar 

  4. Office of Health Economics, the International Federation of Pharmaceutical Manufacturers’ Associations. Trends in economic evaluation. The Health Economic Evaluations Database (OHE HEED). (2004). London. OHE-IFPMA. OHE Briefing: England.

    Google Scholar 

  5. Ungar, W. J., & Santos, M. T. (2004). Trends in pediatric health economic evaluation: 1980 to 1999. Archives of Disease in Childhood, 89, 26–29.

    PubMed  CAS  Google Scholar 

  6. Ungar, W. J., & Gerber, A. (2010). The uniqueness of child health and challenges to measuring costs and consequences. In W. J. Ungar (Ed.), Economic evaluation in child health (pp. 1–32). Oxford: Oxford University Press.

    Google Scholar 

  7. Sung, L., Petrou, S., & Ungar, W. J. (2010). Measurement of health utilities in children. In W. J. Ungar (Ed.), Economic evaluation in child health (pp. 77–90). Oxford: Oxford University Press.

    Google Scholar 

  8. Prosser, L. A., Hammitt, J. K., & Keren, R. (2007). Measuring health preferences for use in cost-utility and cost-benefit analyses of interventions in children: theoretical and methodological considerations. Pharmacoeconomics, 25, 697–702.

    Article  Google Scholar 

  9. Prosser, L. A. (2009). Current challenges and future research in measuring preferences for pediatric health outcomes. Journal of Pediatrics, 155, 7–9.

    Article  PubMed  Google Scholar 

  10. Petrou, S. (2003). Methodological issues raised by preference-based approaches to measuring the health status of children. Health Economics, 12, 697–702.

    Article  PubMed  Google Scholar 

  11. Griebsch, I., Coast, J., & Brown, J. (2005). Quality-adjusted life-years lack quality in pediatric care: A critical review of published cost-utility studies in child health. Pediatrics, 115, e600–e614.

    Article  PubMed  Google Scholar 

  12. Tarride, J. E., Burke, N., Bischof, M., Hopkins, R. B., Goeree, L., Campbell, K., et al. (2010). A review of health utilities across conditions common in pediatric and adult populations. Health and Quality of Life Outcomes, 8, 1–11.

    Article  Google Scholar 

  13. The EuroQol Group. (1990). EuroQol: A new facility for the measurement of health related quality of life. Health Policy, 16, 199–208.

    Article  Google Scholar 

  14. Apajasalo, M., Sintonen, H., Holmberg, C., Sinkkonen, J., Aalberg, V., Pihko, H., et al. (1996). Quality of life in early adolescence: A sixteen dimensional health-related measure (16D). Quality of Life Research, 5, 205–211.

    Article  PubMed  CAS  Google Scholar 

  15. Ungar, W. J., Mirabelli, C., Cousins, M., & Boydell, K. M. (2006). A qualitative analysis of a dyad approach to health-related quality of life measurement in children with asthma. Social Science and Medicine, 63, 2354–2366.

    Article  PubMed  Google Scholar 

  16. Wang, Q., Furlong, W., Feeny, D., Torrance, G., & Barr, R. (2002). How robust is the health utilities index mark 2 utility function? Medical Decision Making, 22, 350–358.

    PubMed  CAS  Google Scholar 

  17. Keren, R., Pati, S., & Feudtner, C. (2004). The generation gap: Differences between children and adults pertinent to economic evaluations of health interventions. Pharmacoeconomics, 22, 71–81.

    Article  PubMed  Google Scholar 

  18. Matza, L., Swensen, A., Flood, E., Secnik, K., & Leidy, N. K. (2004). Assessment of health-related quality of life in children: A review of conceptual, methodological, and regulatory issues. Value in Health, 7, 79–92.

    Article  PubMed  Google Scholar 

  19. Eiser, C., & Morse, R. (2001). Quality-of-life measures in chronic diseases of childhood. Health Technology Assessment, 5, 1–157.

    PubMed  CAS  Google Scholar 

  20. Saigal, S., Stoskopf, B. L., Feeny, D., Furlong, W., Burrows, E., Rosenbaum, P. L., et al. (1999). Differences in preferences for neonatal outcomes among health care professionals, parents, and adolescents. Journal of the American Medical Association, 281, 1991–1997.

    Article  PubMed  CAS  Google Scholar 

  21. Dickie, M., & Gerking, S. (2006). Valuing children’s health: parental perspectives. In economic valuation of environmental health risks to children (pp. 121–158). Paris: Organisation for Economic Cooperation and Development.

  22. Neumann, P. J., Greenberg, D., Olchanski, N. V., Stone, P. W., & Rosen, A. B. (2005). Growth and quality of the cost-utility literature, 1976–2001. Value in Health, 8, 3–9.

    Article  PubMed  Google Scholar 

  23. Gold, M. R., Siegel, J. E., Russell, L. B., & Weinstein, M. C. (1996). Cost-effectiveness in health and medicine (1st ed.). New York: Oxford University Press.

    Google Scholar 

  24. Drummond, M. F., Sculpher, M. J., Torrance, G. W., O’Brien, B. J., & Stoddart, G. L. (1997). Methods for the economic evaluation of health care programmes (2nd ed.). Oxford: Oxford University Press.

    Google Scholar 

  25. Pediatric Economic Database Evaluation. Toronto’s hospital for sick children, http://pede.ccb.sickkids.ca/pede/index.jsp. Accessed on 12 Jul 2009.

  26. Ungar, W. J., & Santos, M. T. (2003). The pediatric economic database evaluation (PEDE) project: Establishing a database to study trends in pediatric economic evaluation. Medical Care, 41, 1142–1152.

    Article  PubMed  Google Scholar 

  27. World Health Organization. (2007). International statistical classification of diseases and related health problems 10th revision version for 2007. World Health Organization. http://apps.who.int/classifications/apps/icd/icd10online/. Accessed on 10 May 2009.

  28. Ungar, W. J., & Santos, M. T. (2003). The pediatric quality appraisal questionnaire: An instrument for evaluation of the pediatric health economics literature. Value in Health, 6, 584–594.

    Article  PubMed  Google Scholar 

  29. Ungar, W. J., & Santos, M. T. (2005). Quality appraisal of pediatric health economic evaluations. International Journal of Technology Assessment in Health Care, 21, 203–210.

    PubMed  Google Scholar 

  30. Au, F., Prahardhi, S., & Shiell, A. (2008). Reliability of two instruments for critical assessment of economic evaluations. Value in Health, 11, 435–439.

    Article  PubMed  Google Scholar 

  31. Ladapo, J., Neumann, P., Keren, R., & Prosser, L. A. (2007). Valuing children’s health: A comparison of cost-utility analyses for adult and pediatric health interventions in the US. Pharmacoeconomics, 25, 817–828.

    Article  PubMed  Google Scholar 

  32. Eisenberg, D., & Freed, G. L. (2007). Reassessing how society prioritizes the health of young people. Health Affairs, 26(2), 345–354.

    Article  PubMed  Google Scholar 

  33. Brouwer, W. B. F., Niessen, L. W., Postma, M. J., & Rutten, F. F. (2005). Need for differential discounting of costs and health effects in cost effectiveness analyses. British Medical Journal, 331, 446–448.

    Article  PubMed  Google Scholar 

  34. Cairns, J. A. (2006). Discounting of children’s health: conceptual and practical difficulties. In economic valuation of environmental health risks to children (pp. 187–206). Paris: Organisation for Economic Cooperation and Development.

  35. McGhan, W. F., Al, M., Doshi, J. A., Kamae, I., Marx, S. E., & Rindress, D. (2009). The ISPOR good practices for quality improvement of cost-effectiveness research task force report. Value in Health, 12(8), 1086–1099.

    Article  PubMed  Google Scholar 

  36. Neumann, P. J., Rosen, A. B., Greenberg, D., Olchanski, N. N., Pande, R., Chapman, R. H., et al. (2005). Can we better prioritize resources for cost-utility research? Medical Decision Making, 25, 429–436.

    Article  PubMed  Google Scholar 

  37. Carroll, A. E., & Downs, S. M. (2009). Improving decision analyses: parent preferences (utility values) for pediatric health outcomes. Journal of Pediatrics, 155, 21–25.

    Article  PubMed  Google Scholar 

  38. Petrou, S., & Kupek, E. (2009). Estimating preference-based health utilities index mark 3 utility scores for childhood conditions in England and Scotland. Medical Decision Making, 29, 291–303.

    Article  PubMed  Google Scholar 

  39. Varni, J., Burwinkle, T., & Lane, M. (2005). Health-related quality of life measurement in pediatric clinical practice: An appraisal and precept for future research and application. Health and Quality of Life Outcomes, 3, 1–9.

    Article  Google Scholar 

  40. Moodie, M., Richardson, J., Rankin, B., Iezzi, A., & Sinha, K. (2010). Predicting time trade-off health state valuations of adolescents in four Pacific countries using the assessment of quality-of-life (AQoL-6D) instrument. Value in Health, 13(8), 1014–1027.

    Article  PubMed  Google Scholar 

  41. Wille, N., Badia, X., Bonsel, G., Burström, K., Cavrini, G., Devlin, N., et al. (2010). Development of the EQ-5D-Y: A child-friendly version of the EQ-5D. Quality of Life Research, 19(6), 875–886.

    Article  PubMed  Google Scholar 

  42. Stevens, K. J. (2010). Working with children to develop dimensions for a preference-based, generic, pediatric, health-related quality-of-life measure. Qualitative Health Research, 20(3), 340–351.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors gratefully acknowledge these sources of financial support: Ontario Ministry of Health and Long-term Care Drug Innovation Fund; Alberta Innovates-Health Solutions Studentship (funded by the Alberta Heritage Foundation for Medical Research Endowment Fund) to SKK; studentship funding from the Department of Health Policy, Management, and Evaluation, University of Toronto to SKK, Ontario Mental Health Foundation studentship funding to JB. This study received in kind support from the Hospital for Sick Children Research Institute. The views expressed in the present study are the views of the research team and do not necessarily reflect those of the Province of Ontario. Sources of Financial Support: Ontario Ministry of Health and Long-term Care Drug Innovation Fund; Alberta Innovates-Health Solutions Studentship (funded by the Alberta Heritage Foundation for Medical Research Endowment Fund) to SKK; studentship funding from the Department of Health Policy, Management, and Evaluation, University of Toronto, to SKK; Ontario Mental Health Foundation studentship funding to JB. This study received in kind support from the Hospital for Sick Children Research Institute.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wendy J. Ungar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kromm, S.K., Bethell, J., Kraglund, F. et al. Characteristics and quality of pediatric cost-utility analyses. Qual Life Res 21, 1315–1325 (2012). https://doi.org/10.1007/s11136-011-0049-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-011-0049-7

Keywords

Navigation